Risk Factors Of Cardiac Valve Calcification In Patients With Chronic Kidney Disease

Objective:The objective is to provide a theoretical basis for the prevention of cardiac valve calcification（CVC）and improvement of cardiac prognosis in patients with chronic kidney disease（CKD）.Through analyzing the possible risk factors for cardiac valve calcification in chronic kidney disease.Methods:A total of 626 patients with chronic kidney disease hospitalized in the Department of Nephrology,China-japan Union Hospital of Jilin University from January 2020 to October 2021 were selected,and information were collected about their age,gender,height,weight,body mass index,previous medical history（hypertension,diabetes,coronary heart disease,cerebral infarction）,Systolic blood pressure 、 Diastolic blood pressure,whether underwent parathyroidectomy,and dialysis result;their serological parameters: hemoglobin,calcium,phosphorus,magnesium,parathyroid hormone（PTH）,triglycerides（TG）,total cholesterol（TC）,low density lipoprotein（LDL-C）cholesterol（LDL-C）,high density lipoprotein cholesterol（HLD-C）,Total protein（Tp）,albumin（Alb）,globulin（Glb）,albumin/globulin ration（A/G）,alkaline phosphatase（ALP）,Cystatin C（Cys C）,blood urea（BUN）,creatinine（Scr）,Apolipoprotein A1（Apo A1）,Apolipoprotein B（Apo B）,Lipoprotein（a）（Lp（a））;and their ultrasound cardiogram of heart valve calcification,left atrial dimension（LA）,left ventricular ejection fraction（LVEF）,fraction shortening（FS）,stroke volume（SV）,Interventricular septal thickness（IVS）,Left ventricular end diastolic diameter,（LVD）,Posterior wall thickness of left ventricle（LVPW）,Left ventricular end-diastolic volume（EDV）,cardiac output（CO）,peak mitral valve diastolic early flow velocity（E-peak）,peak mitral valve diastolic late flow velocity（A-peak）,E/A,E/e,peak mitral annular diastolic early flow velocity（e）,peak mitral annular diastolic late flow velocity（a）,e/a,E/e.Data were statistically analyzed using SPSS 26.0 statistical software.Normality of all continuous data was assessed using the Shapiro-Wilk test.When the measurement data were normally distributed,the trend of distribution was described and the independent samples t-test was performed to compare the data between the two groups;when the data were not normally distributed,the trend of distribution was described by M（P25,P75）and the Mann-Whitney U test was performed to compare the data between two groups.Enumeration data were expressed as cases（%）,and the chi-square test or Fisher’s exact test was conducted to compare data between groups.Dichotomous logistic regression analysis was applied to assess risk factors for CVC in patients with CKD,and independent variables with P≤0.1 in univariate were included in the multifactorial analysis.OR values and 95% confidence intervals were calculated.Statistical analysis was performed using SPSS26,and differences were considered statistically significant at P < 0.05.Results:1.The prevalence of CVC in patients with CKD in our study center was 35.6%,with a prevalence of aortic valve calcification higher than that of mitral valve calcification.2.Senior age（OR1.052,95% CI1.032-1.073,P<0.001）,reduced BMI（OR0.916,95% CI0.863-0.971,P=0.003）,coronary artery disease（OR2.12,95% CI1.346-3.340,P=0.001）,left ventricular hypertrophy（OR1.849.95% CI1.176-2.909,P=0.008）,valvular insufficiency（OR1.709,95% CI1.037-2.817,P=0.036）,increased FS（OR1.041,95% CI1.006-1.077,P=0.022）were the risk factors for CVC in patients with CKD,and elevated apolipoprotein A1（OR0.351,95% CI0.125-0.894,P=0.047）served as a protective factor.3.The prevalence in patients on dialysis >1 year was higher than that in patients on dialysis within 0-1 year.The prevalence of CVC was not related to the duration of dialysis.4.Senior age（OR1.049,95% CI1.021-1.077,P<0.001）,reduced BMI（OR0.931,95% CI0.871-0.996,P=0.037）,valve closure insufficiency（OR2.039,95%CI1.112-3.737,P=0.021）,left ventricular hypertrophy（OR2.315,95%CI1.281-4.184,P=0.005）were the risk factors for CVC in patients with CKD but no dialysis.5.Senior age（OR1.070,95% CI1.036-1.106,P<0.001）,diabetes mellitus（OR2.293,95% CI1.147-4.585,P=0.019）,coronary heart disease（OR3.32,95%CI1.572-7.01,P=0.002）were risk factors for CVC in patients with CKD on dialysis,and elevated apolipoprotein A1（OR0.17,95% CI0.031-0.933,P=0.041）served as a protective factors.Conclusion:1.In this study,The prevalence of CVC in patients with CKD in our study center was 35.6% and the prevalence of aortic valve calcification was higher in patients with CKD than mitral valve calcification,and the prevalence of CVC was higher in CKD patients with >1 year of dialysis than in CKD patients with <1 year of dialysis.2.Senior age,reduced BMI,coronary artery disease,left ventricular hypertrophy,and increased left ventricular systolic function were risk factors for CVC in patients with CKD,and valvular insufficiency,and LV hypertrophy were more likely to promote the progression of CVC in patients with CKD but no dialysis;diabetes mellitus would promote the progression of CVC in dialysis patients.3.Elevated apolipoprotein A1 served as a protective factor for CVC in dialysis patients with CKD.